Role of ankle foot orthoses in functional stability of individuals with stroke

Purpose: Ankle foot orthoses (AFOs) are frequently prescribed to improve ambulation in individuals with stroke. However, the role of AFOs in balance control is not completely understood. The aim of the study was to evaluate the contribution of the AFOs in functional stability of individuals with stroke. Methods: Twenty three individuals with unilateral hemiparesis due to stroke were assessed using the Functional Reach Test. The subjects performed reaches forward, left and right while standing with or without an AFO. Results: When provided with AFO, individuals with stroke improved the maximal reaching distance in all the directions (p?<?0.05). Conclusions: The study found that individuals with unilateral stroke clearly demonstrated improvements in functional stability when they were provided with AFOs. This outcome could be used in the optimization of balance rehabilitation of individuals with stroke.

• Implications for Rehabilitation

• Functional stability is impaired in individuals with stroke.

• Functional Reach Test (FRT) was used to assess the role of ankle foot orthoses (AFOs) in balance control.

• Individuals with stroke improved their functional stability while they were provided with AFOs.

• Functional Reach Test could assist clinicians in the evaluation of postural stability associated with the use of AFOs.

     

踝足矫形器早期应用对卒中患者足踝控制能力的sEMG研究

目的：本文探讨足踝矫形器早期应用对脑卒中偏瘫患者足踝控制能力的作用及价值。方法：诊断明确的脑卒中患者48例,随机分为早期支具组（ZJ组）和对照组（D组）各24例,均按常规对症支持治疗。ZJ组早期患足加穿定制的硬塑固定踝足矫形器,D组则病程〉1个月后开始穿戴或不戴。2组均在治疗前后进行表面肌电图（sEMG）检测及下降Fugl-Meyer（FMA）评定。结果：治疗1个月后,小腿胫前肌、腓肠肌积分肌电值（iEMG值）与治疗前比较,2组均明显增加,下肢简化FMA评分均明显提高（均P〈0.01）。腓肠肌iEMG值在踝关节背伸等长收缩时小腿肌群的协同收缩率,ZJ组明显低于D组（P〈0.05）。结论：早期使用踝足矫形器可有效缓解踝背伸活动时拮抗肌的痉挛、增强胫前肌肌力,改善踝关节活动范围,对促进足下垂的恢复有明显作用。     

Foot and ankle impairments affect balance and mobility in stroke (FAiMiS): the views and experiences of people with stroke

Purpose: To explore the nature and impact of foot and ankle impairments on mobility and balance in community-dwelling, chronic stroke survivors. Methods: A qualitative research design using face to face semi-structured, audio recorded interviews. Thirteen community-dwelling stroke survivors, all of whom had self-reported foot and ankle impairments, were interviewed (female n?=?6, mean age?=?67 years, SD?=?12 years, mean time since stroke?=?4 years, SD?=?6 years, right stroke n?=?7, left stroke n?=?6). A framework analysis approach was used to analyse and interpret transcribed interviews. Results: Three themes emerged: (1) Impact. The influence of foot and ankle impairments on mobility and balance. (2) Standing out. How participants felt they “stood out” because of their impairments and wanted to be normal. (3) Help. The specific help and advice participants received in managing their problems. Conclusions: Foot and ankle impairments such as pain, altered somatosensory input and weakness significantly contribute to problems with community ambulation, balance and fear of falling in people with chronic stroke. Specific foot and ankle impairments may also negatively contribute to perceptions of physical appearance and self-esteem. Therapeutic management approaches within clinical practice appear to focus mostly on the gross performance of the lower limb with little emphasis on the specific assessment or treatment of the foot or ankle.

• Implications for Rehabilitation

• Foot pain, sensory impairments and muscle weakness in the foot and ankle can impact on community ambulation, balance and fear of falling following stroke.

• Foot and ankle function post-stroke should be routinely assessed and monitored.

• Clinicians should be aware of the potentially distressing negative perceptions associated with altered gait patterns, footwear and orthotic use.

     

步态诱发功能性电刺激对脑卒中足下垂患者的疗效观察

目的:观察应用低频脉冲电刺激治疗脑卒中后足下垂患者的疗效。方法:对30例脑卒中后导致足下垂的患者,在常规药物治疗、康复治疗的基础上,每天采用低频电子脉冲刺激仪对患侧腓总神经、胫前肌进行电刺激治疗,每天2次,其中第一次为训练模式,只进行患侧胫前肌的神经肌肉电刺激治疗20min;第二次在同样NMFS的同时进行步行训练15—20min。每周5—6d,共2周。治疗前先使用神经肌肉定位仪找准敏感位置,然后将阴极至于敏感部位(腓总神经),阳极至于合适部位(胫前肌)。分别在治疗前、治疗1周、2周行下肢步行功能的评定,分别测定不戴和佩戴刺激仪的StepTest评定、10m最大步行速度测试、上下8个台阶时间、生理耗能指数。结果:治疗2周后与治疗前比较,患者下肢步行功能有明显改善,佩戴刺激仪步行时可即刻明显提高脑卒中后足下垂患者的步速、体位转移能力、上下楼梯能力及降低生理耗能(P<0.05—0.001)。结论:低频脉冲电刺激能改善脑卒中患者步行功能,佩戴低频电子脉冲刺激仪步行时可即刻明显提高患者的步速、体位转移能力、上下楼梯能力及降低生理耗能,而且无明显不良反应,是一种安全有效的训练仪器。     

功能电刺激治疗脑卒中足下垂合并内翻的疗效观察

目的:观察动作反馈的功能性电刺激(FES)对脑卒中足下垂合并足内翻患者下肢运动功能和步行能力的影响。方法:脑卒中足下垂合并足内翻患者34例,随机分为观察组和对照组各17例,2组均进行基础康复治疗,观察组另行功能电刺激下20min步行训练,对照组行相同时间的常规步行训练。在康复治疗前和治疗4周后采用Fug1-Meyer量表下肢部分(FMA-LE)、起立-行走计时测试(TUGT)、徒手肌力测试(MMT)和改良Ashworth量表(MAS)对两组患者进行功能评估;观察组另记录步态不对称指数(GAI)和非偏瘫侧摆动时间变异(STV)。结果:治疗4周后,观察组患者FMA-LE、TUGT、MMT、MAS、GAI和STV评分均较治疗前显著提高(P0.05),对照组TUGT及MMT评分较治疗前明显提高(P0.05),其余各评分治疗前后比较均差异无统计学意义;治疗后组间比较,观察组FMA-LE、TUGT和MAS评分均显著高于对照组(P0.05),但MMT评分组间比较差异无统计学意义。结论:动作反馈功能性电刺激能显著改善脑卒中足下垂合并足内翻患者的运动功能和步行能力,并能提高踝背屈肌力、缓解踝关节相关肌群痉挛。     

踝足矫形器对足下垂患者下肢功能影响的分析

目的观察和分析足下垂患者穿戴踝足支具(AFO)前后对下肢稳定性、负重能力、步行中膝、踝关节活动的影响.方法20例足下垂患者(男14例,女6例),其中右侧足下垂者9例,左侧足下垂者13例.患者中有6例需在辅助下行走,14例已具备独立行走的条件.对所有患者分别在穿戴和不穿戴踝支具状态下进行步行能力、下肢活动能力、身体平衡功能测定.其中5例患者在穿戴支具1个月左右进行步态分析.结果穿戴AFO后即刻患者的步行速度和步幅影响与穿戴支具前比较无显著差异(P＞0.05);踏车时间和上楼的速度比不戴支具有明显提高(P＜0.05),而起蹲、下楼时间、足抬高距离无显著差异(P＞0.05);穿戴AFO对患肢负重无明显改善(P＞0.05),但可使患者身体左右的稳定性及患腿前后的稳定性有明显改善(P＜0.05);步态分析结果发现,5例患者穿戴支具前后患侧下肢垂直峰力矩、步速无明显影响(P＞0.05);穿戴AFO后患侧膝关节在步行周期中最大伸膝度数较不穿支具明显减少(P＜0.05);患侧踝关节在步态周期中最大趾屈度数较不穿支具明显减少(P＜0.01).结论AFO对下肢功能的影响主要表现在改善足下垂和膝过伸程度;增强身体稳定性及患侧下肢稳定性;穿戴AFO对患者下肢日常功能活动无明显影响;对患者即刻和1个月以后的步速、步幅、患腿负重能力的改善不明显.     

脑卒中足下垂患者摆动相骨盆运动特征分析

目的:研究脑卒中足下垂患者摆动相骨盆运动特征,探讨骨盆代偿机制.方法:选取脑卒中足下垂患者30例作为试验组,30例健康者作为对照组,按照与试验组偏瘫侧、非偏瘫侧左右一致、性别相同的原则,将对照组左右侧数据分为对照组1、对照组2.运用三维步态分析系统采集、分析试验组和对照组的时空参数及摆动相骨盆、踝关节运动学参数,并对偏...     

The effect of foot plantar massage on balance and functional reach in patients with type II diabetes

Objective: The aim of this study was to investigate the effect of manual foot plantar massage (classic and friction massage) on functional mobility level, balance, and functional reach in patients with type II diabetes mellitus (T2 DM). Methods: A total of 38 subjects diagnosed with T2 DM were included in the study. A healthy control group could not be formed in this study. After the subjects’ socio-demographic data were obtained, Timed Up & Go (TUG) Test, functional reach test (FRT), one-leg standing test with eyes open-closed, and Visual Analogue Scale (VAS) to measure foot pain intensity were performed. The results were also divided and assessed in three groups according to the ages of the individuals (40–54, 55–64, and 65 and over). Results: As a result of statistical analysis, a difference was found in the values obtained from TUG, FRT, and one-leg standing test with eyes open and closed (p < 0.05). Following the massage, TUG values significantly decreased comparison with those before the massage, whereas the values of FRT and one-leg standing test with eyes open and closed significantly increased compared with those before the massage (p > 0.05). According to age groups, there were statistical differences (p < 0.05) between the TUG, one-leg standing test with eyes open and closed test values of the individuals before and after the massage. Conclusions: The results of our study indicated that application of plantar massage to patients with T2 DM caused an improvement in balance, functional mobility, and functional reach values. An increase in body balance and functional mobility may explain the improvement in TUG. Foot massage to be added to rehabilitation exercise programs of DM patients will be important in improving balance and mobility of patients.     

三维步态在脑卒中足下垂患者下肢节段协调性分析的应用

目的:运用三维步态分析系统分析脑卒中偏瘫足下垂患者的下肢关节协调性.方法:选取脑卒中偏瘫足下垂患者15例作为观察组,配对设计选取15例健康者作为对照组一和对照组二.采集2组受试者行走过程中的时空参数和运动学参数,通过绘制仰角曲线图和步态环图进行协调性分析.结果:观察组偏瘫侧与非偏瘫侧比较,步频、支撑期百分比,髋、膝关节...     

A pilot study to investigate the combined use of Botulinum toxin type-a and ankle foot orthosis for the treatment of spastic foot in chronic hemiplegic patients

Background

Botulinum toxin is commonly used to treat spastic equinus foot. This treatment seems to improve gait in hemiplegic patients when used alone or combined with an ankle-foot orthosis. However, the nature and effects of this improvement have until now rarely been studied. The aim of this study was to quantify the impact of a Botulinum toxin injection in the triceps surae of hemiplegic patients with equinus foot, used either alone or in combination with an ankle-foot orthosis, on the kinematics and dynamics of the paretic lower limb, and to determine the advantage of combining an ankle-foot orthosis with this pharmacological treatment.

Methods

Patients were assessed using gait analysis to measure spatio-temporal, kinematic and dynamic parameters of the gait cycle before Botulinum toxin injection and then 3 and 6 weeks after injection. Eight chronic hemiplegics following central nervous system lesion were included.

Findings

Botulinum toxin injection led to an increase in velocity, peak ankle dorsiflexion during stance phase, and peak knee flexion during swing phase. It also resulted in an increased peak plantarflexion moment. Use of ankle-foot orthosis led to a specific increase in peak ankle dorsiflexion during swing phase and also increased peak plantarflexion moment.

Interpretation

The results indicate that combined Botulinum toxin injection of the triceps surae and wearing an ankle-foot orthosis is more effective than the use of Botulinum toxin only. Use of an ankle-foot orthosis increases ankle dorsiflexion during the swing phase and does not reduce the benefits gained by the use of Botulinum toxin in stance phase.     

应用平衡功能检测训练系统改善脑卒中患者平衡功能的疗效观察

目的 观察应用PH—A型平衡功能检测训练系统对脑卒中偏瘫患者进行平衡功能训练的疗效。方法 将108例脑卒中偏瘫患者分为治疗组（68例）和对照组（40例）。对照组给予常规药物治疗和物理因子治疗，治疗组在常规治疗的基础上同时应用PH—A型平衡功能检测训练系统对患者进行平衡功能训练，2组患者在治疗前、后分别应用该系统检测和Berg平衡功能评定表（BBS）进行评定。平衡检测分别在坐位、双足站立位（睁眼和闭眼状态下）进行，取摆幅指数、重心分布区域、摆动的轨迹长、外周面积4个指标进行分析。结果 2组患者治疗后BBS评定和平衡检测均有明显改善，其中治疗组的坐位分布区域好转，但无统计学意义（P〉0．05），BBS评定和平衡检测站立位各指标均有显著好转（P〈0．001）；治疗后2组比较差异有统计学意义（P（0、05～P〈0、01），治疗组临床疗效明显优于对照组。结论 运用PH—A型平衡功能检测训练系统对偏瘫患者进行平衡功能训练，可以显著提高患者的站立平衡功能。     

步态诱发功能性电刺激对脑卒中后足下垂患者步态时空参数的影响

目的:采用步态分析,观察步态诱发功能性电刺激对脑卒中后足下垂患者步态时空参数的影响.方法:选择40例符合入选标准的脑卒中后足下垂患者,随机分组到实验组和对照组,均给予常规药物治疗及基本常规康复训练.实验组在此治疗基础上采用给予患侧下肢步态诱发功能性电刺激,根据患者踝关节背伸、内翻程度调节正负电极片位置及具体适应的刺激量30min/次,1次/d,每周6次,共3周.对照组在治疗期间不给予任何电刺激.采用三维步态分析仪器分别于治疗前、治疗3周后检测并获取两组患者步态参数.结果:治疗3周后,两组患者步速、步幅、步频、健侧摆动相均较治疗前明显均提高(P＜0.05),步态周期、步宽、双支撑相、患侧摆动相、健侧支撑相、患侧支撑相均较治疗前显著减小(P＜0.05).组间比较显示,治疗组患者的步行速度、步幅、步频、步行周期、步宽、双支撑相、改善程度均明显优于对照组(P＜0.05).两组患者对称性步态参数治疗前后差异显著,且实验组改善程度显著优于对照组(P＜0.05).结论:步态诱发功能性电刺激治疗能有效改善脑卒中后足下垂患者步速、步频、步行周期等时空参数,提高脑卒中后足下垂患者的步行能力及步态的对称性.     

功能性电刺激辅助步行设备对脑卒中足下垂患者步态时空参数的影响

目的:观察应用功能性电刺激辅助步行设备(FES-AWD)对脑卒中足下垂患者步态时空参数的影响,为临床治疗提供理论依据.方法:9例脑卒中足下垂患者在常规康复治疗基础上,增加步态训练矫正仪辅助下的步行训练,每天2次,每次20min,每周5d,共4周;分别于治疗开始前、治疗1周后和治疗4周后利用三维步态分析系统分析患者佩戴步态训练矫正仪前后的步态时-空参数.结果:①与自由步行相比,佩戴步态训练矫正仪(关闭开关)对患者的步态时空参数无显著影响;②3次访视中,与自由步行相比,佩戴步态训练矫正仪(开启开关)均能显著提升足下垂患者的步态时空参数.结论:FES-AWD可以即刻改善脑卒中足下垂患者的步态,且可以排除心理影响,以及佩戴设备所产生的各种不利生理影响.     

早期AFO干预对脑卒中患者日常生活活动能力及生存质量的影响

目的探讨早期使用踝足矫形器（AFO）对脑卒中偏瘫患者13常生活活动（ADL）能力和生存质量（QOL）的功能结局影响。方法将21例早期脑卒中偏瘫患者随机分为治疗组（11例）和对照组（10例）。治疗组采用AFO与常规康复干预治疗，对照组则予以常规康复干预。每组患者入选时及治疗3个月后分别使用改良巴氏指数（MBI）评定13常生活活动能力和简化SF-36生存质量量表（中文版）评定生存质量。结果2组患者治疗前的一般情况及病情比较，差异均无统计学意义（P〉0．05）；治疗3个月后，2组患者13常生活活动能力和生存质量间差异具有统计学意义（P〈0．05）。结论早期使用AFO可以显著促进急性脑卒中偏瘫患者日常生活活动能力和生存质量改善。     

低频重复经颅磁刺激联合平衡仪训练对脑卒中患者平衡功能的影响

目的：探索运动平衡仪训练联合rTMS治疗对改善脑卒中患者平衡功能的效果。方法：脑卒中患者80例按随机数字法将患者分为2组各40例。其中观察组8例脱落，共32例完成治疗，对照组3例脱落，共37例完成治疗。对照组在常规康复治疗的基础上针对平衡功能障碍运用动态平衡仪进行训练，观察组在常规康复治疗的基础上联合运用动态平衡仪及低频rTMS治疗，2组患者均治疗满2个疗程,共24次治疗。分别于治疗前后对2组患者进行BBS评分、FMB评分、Pro-Kin平衡仪测试评定。结果：治疗4周后，2组BBS评分、FMB评分、运动长度及运动椭圆面积均较治疗前明显提高（P＜0.05），且观察组各项观察指标均明显高于对照组（P＜0.05）。结论：低频rTMS治疗联合平衡仪治疗在改善脑卒中患者平衡功能上效果显著，较单独使用平衡仪治疗有明显优势。     

Translation,cross-cultural adaptation and validity of the Brazilian version of the Foot and Ankle Ability Measure questionnaire

Purpose: To translate and cross-culturally adapt the Foot and Ankle Ability Measure (FAAM) questionnaire and verify the psychometric properties of the Brazilian–Portuguese version of this instrument.

Methods: Analysis of validity was carried out by applying the Rasch model and evaluating correlations with the Short Form-36 (SF-36) Physical Function (PF) subscale. Test–retest reliability and internal consistency were analyzed with the intraclass correlation coefficient (ICC_2,1) and Cronbach’s alpha tests, respectively.

Results: Ninety subjects with various foot and ankle musculoskeletal disorders (age 37.05 SD 10.49 years) were included. The ICC_2,1 was 0.88 and 0.82 with Cronbach’s alphas of 0.93 and 0.90 for the “Activities of Daily Living” (ADL) and “Sports” subscales, respectively. Correlations with the SF-36 PF were 0.78 (p?95: 0.62–0.87) and 0.65 (p?95: 0.45–0.79) for the ADL and Sports subscales, respectively. Item reliability indices in Rasch analysis were 0.91 (ADL) and 0.84 (Sports). Three items from the ADL subscale (14.2%) did not match the expectations of the model. All items from the Sports subscale fit the model.

Conclusions: There is evidence of validity and reliability of the FAAM-Brazil. Rasch analysis indicated that three items of the ADL subscale did not fit the model in the sample studied.

• Implications for Rehabilitation

• Self-report questionnaires are commonly used in both clinical practice and research because of their ability to efficiently collect information. If the instrument is created properly, the information collected can be used to interpret the effect of clinical conditions on physical function.

• The Foot and Ankle Ability Measure (FAAM) is an evaluative instrument that assesses functional limitations for those with foot- and ankle-related disorders. It was translated into four languages and has evidence of validity, reliability, and responsiveness.

• Evidence of validity and reliability is provided for the FAAM-Brazil when applied to subjects with a wide range of foot and ankle musculoskeletal disorders.

     

太极拳对脑卒中后患者平衡功能效果的Meta分析

目的：探讨太极拳对脑卒中后患者平衡功能的影响。方法：检索多个中英文数据库中有关太极拳对脑卒中后患者平衡功能影响的随机对照试验（RCT）。按照纳入和排除标准筛选文献、提取资料并评价纳入研究的方法学质量后,采用RevMan5.3进行数据分析。结果：太极拳组在Berg平衡量表得分（BBS）［MD=11.43,95%CI（7.43,15.42）,P<0.00001］、减少起立行走时间（TUG）［MD=-2.26,95%CI（-5.17,0.66）,P=0.13］、肢体平衡功能（FMA）［MD=12.77,95%CI（-5.07,30.60）,P=0.16］方面优于对照组,但只有在BBS得分上差异有统计学意义,TUG和FMA方面差异没有统计学意义。结论：虽然BBS的研究结果证明太极拳有助于提高脑卒中后患者的平衡功能,但今后仍需要设计更为严谨、质量更高、更大样本量的RCT来进一步验证太极拳提高脑卒中后患者身体平衡功能、肢体平衡功能、起立行走时间等的效果。     

神经肌肉电刺激联合运动贴布对脑卒中后足下垂患者康复中应用价值

目的:探讨神经肌肉电刺激(NMES)联合运动贴布对脑卒中后足下垂的康复效果.方法:脑卒中后足下垂患者70例随机分为2组各35例,2组均接受运动训练和姿势控制训练等常规康复训练,在此基础上,NMES组接受NMES治疗,联合组接受NMES联合运动贴布治疗,疗程均为4周.比较2组治疗前后踝关节背屈角度、足内翻角度、足下垂角度...